Analysis of time to death for children with life-threatening hemorrhage from traumatic, surgical, and medical etiologies.

IF 2.5 3区医学 Q2 HEMATOLOGY

Transfusion Pub Date : 2025-03-23 DOI:10.1111/trf.18144

Rachel P Vaizer, Christine M Leeper, Liling Lu, Cassandra D Josephson, Julie C Leonard, Mark H Yazer, Joshua B Brown, Philip C Spinella

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引用次数: 0

Abstract

Introduction: Life-threatening hemorrhage (LTH) is a significant cause of mortality in pediatrics. Timing of mortality in children with LTH is important for future trials.

Methods: In a secondary analysis of the prospective observational massive transfusion in children (MATIC) study, time-to-event analysis was performed to determine timing of death based on etiology of LTH and cause of death.

Results: There were 449 children with LTH; the etiologies of LTHs included trauma (46%), operative (34%), and medical (20%). The cause of death at 24 h in the trauma group was 56% from hemorrhage and 42% from central nervous system (CNS) failure; in operative group it was 94% from hemorrhage and 6% CNS failure; in medical group it was 84% hemorrhage and 3% CNS failure. The median (interquartile range [IQR]) time to death (hours) varied by cause of death (hemorrhagic: 3.3 [1.0-10.3], CNS failure: 30.4 [9.0-63.6]). For traumatic LTH, 90% of hemorrhage-related deaths occurred within 19 h and 90% of CNS failure deaths occurred within 92 h. For operative LTH, 90% of hemorrhage-related deaths occurred within 5 days and 90% of CNS failure deaths occurred within 28 days. For medical LTH, 90% of hemorrhage-related deaths occurred within 44 h and 90% of CNS failure deaths occurred within 24 days.

Conclusion: In children, timing of death differs according to etiology of LTH and by cause of death. The choice of primary outcome for trials in children with LTH should consider these differences based on the etiology of LTH being studied.

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外伤性、外科和内科原因导致的危及生命的出血儿童的死亡时间分析。

简介：危及生命的出血（LTH）是儿科死亡的重要原因。LTH患儿的死亡时间对未来的试验很重要。方法：对前瞻性观察性儿童大量输血（MATIC）研究进行二次分析，根据LTH的病因和死亡原因进行时间-事件分析，以确定死亡时间。结果：LTH患儿449例；LTHs的病因包括创伤（46%）、手术（34%）和内科（20%）。创伤组24 h死亡原因56%为出血，42%为中枢神经系统功能衰竭；手术组94%为出血，6%为中枢神经系统衰竭；内科组出血占84%，中枢神经系统衰竭占3%。死亡时间中位数（四分位数间距[IQR]）因死亡原因而异（出血性：3.3[1.0-10.3]，中枢神经系统衰竭：30.4[9.0-63.6]）。对于外伤性LTH， 90%的出血相关死亡发生在19小时内，90%的中枢神经系统衰竭死亡发生在92小时内。对于手术LTH， 90%的出血相关死亡发生在5天内，90%的中枢神经系统衰竭死亡发生在28天内。对于医疗LTH， 90%的出血相关死亡发生在44小时内，90%的中枢神经系统衰竭死亡发生在24天内。结论：儿童LTH的死亡时间因LTH的病因和死亡原因而异。LTH患儿临床试验的主要结局选择应考虑LTH病因的差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transfusion 医学-血液学

CiteScore

4.70

自引率

20.70%

发文量

426

审稿时长

1 months

期刊介绍： TRANSFUSION is the foremost publication in the world for new information regarding transfusion medicine. Written by and for members of AABB and other health-care workers, TRANSFUSION reports on the latest technical advances, discusses opposing viewpoints regarding controversial issues, and presents key conference proceedings. In addition to blood banking and transfusion medicine topics, TRANSFUSION presents submissions concerning patient blood management, tissue transplantation and hematopoietic, cellular, and gene therapies.